WOMEN 'S HEALTH AND MENOPAUSE : - National Heart, Lung ...

ange of variables, such as genetic factors, diet,
education, marital status, number of pregnancies,
the kind of work she has carried out, social support,
and access to health care. 52
Access to health
care varies widely
among countries.
Women’s choices
around menopause
are said to bear
consequences for
their health in old
age. For a long time, hot flushes and night sweats
were considered to be core symptoms of menopause
and the most important reason for using HRT.
More recently, HRT has been widely promoted for
prevention against osteoporosis, CVD, and an
array of other conditions. Educated women in
industrialized countries with well-developed medical
care are a privileged group with access to the
most recent information on HRT, whereas other
groups have less access and less knowledge. On
the other hand, medicalization of menopause in
cultures in which menopause is not perceived as a
problem is an important issue that should be debated.
Some critics have questioned the role of the
pharmaceutical industry in influencing health care
through product promotion. 53 Women need education and
balanced information to make
personal decisions regarding
whether to use HRT.
Developing countries
with scarce resources are less likely than developed
countries to allocate funds for care of
menopausal women. In addition, the inequality
among social groups within countries can result in
very different access to information and care.
Promoting positive attitudes to aging and to
menopause could be important in modifying symptoms
and improving the health of women. 54
Women need education and balanced information
to make personal decisions regarding whether to
use HRT. An important goal for health care
providers should be to educate women. Such education
should lead to greater equality among
women in different cultures and social levels and
help women control their own health.
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6. CONCLUSIONS
Menopause has long been considered a turning
point in women’s lives in western cultures.
Although menopause as a physiologic event
remains constant, attitudes toward and beliefs about
menopause vary considerably historically and
cross-culturally. In the past decade, there has been
a heated debate among biomedical and social scientists
as to whether menopause should be seen as
a deficiency disease rather than a natural event.
Cross-cultural comparisons fuel the debate by
showing that the relation between hormones and
symptoms is, indeed, complex. There are significant
differences in patterns and prevalence of
symptoms between countries and, interestingly, in
the types of symptom reported in different ethnic
groups within countries. It is difficult, however, to
draw firm conclusions from available cultural and
ethnographic comparison studies because of a
number of limitations. Among these are differences
among cultures in language used to describe symptoms
and in women’s inclination to report symptoms;
use of different methodologies in study
design and instruments used to measure symptoms;
and differences in diet and other lifestyle factors
that make it difficult to establish cultural versus
biologic reasons for symptom expression. (See ch. 3.)